David R. Nerenz (
J. Matthew Austin is an assistant professor at the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, in Baltimore, Maryland.
Health Aff (Millwood). 2021 Apr;40(4):637-644. doi: 10.1377/hlthaff.2020.01764.
Risk adjustment of quality measures using clinical risk factors is widely accepted; risk adjustment using social risk factors remains controversial. We argue here that social risk adjustment is appropriate and necessary in defined circumstances and that social risk adjustment should be the default option when there are valid empirical arguments for and against adjustment for a given measure. Social risk adjustment is an important way to avoid exacerbating inequity in the health care system.
使用临床风险因素对质量指标进行风险调整已被广泛接受；使用社会风险因素进行风险调整仍存在争议。在此，我们认为在特定情况下，社会风险调整是合理且必要的；并且，当针对特定指标存在支持和反对调整的有效实证论据时，社会风险调整应作为默认选项。社会风险调整是避免加剧医疗体系不公平的重要途径。
